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Phobias

A phobia is an overwhelming and unreasonable fear of an object or situation that poses little real danger. Unlike the brief anxiety most people feel when they give a speech or take a test, a phobia is long-lasting, causes intense physical and psychological distress.

What is it?

A phobia is an overwhelming and unreasonable fear of an object or situation that poses little real danger. Unlike the brief anxiety most people feel when they give a speech or take a test, a phobia is long-lasting, causes intense physical and psychological distress, and can affect your ability to function normally at work or in social settings.

Several types of phobias exist. Some people fear large, open spaces. Others are unable to tolerate certain social situations. And still others have a specific phobia, such as a fear of snakes, elevators or flying.

Not all phobias need treatment, but if a phobia affects your daily life, a number of therapies are available that can help you overcome your fears — often permanently.

Symptoms

Phobias are divided into three main categories:

Specific phobias. These include a fear of enclosed spaces (claustrophobia); animals, particularly spiders, snakes or mice; heights (acrophobia); flying (pterygophobia); water (hydrophobia); storms; dentists; injections; tunnels; bridges; and not being able to get off public transportation quickly enough. There are many other specific phobias.

Social phobia. More than just shyness, social phobia involves a combination of excessive self-consciousness, a fear of public scrutiny or humiliation in common social situations, and a fear of negative evaluation by others.

Fear of open spaces (agoraphobia). Most people who have agoraphobia develop it after having one or more panic attacks. Agoraphobia is a fear of a place, such as a mall, an elevator or a room full of people, with no easy means of escape if a panic attack should occur.

No matter what type of phobia you have, it's likely to produce the following reactions:

A feeling of uncontrollable anxiety when you're exposed to the source of your fear — sitting on an airplane, for instance, or walking into a large party

The feeling that you must do everything possible to avoid what you fear

The inability to function normally because of your anxiety

Often, the knowledge that your fears are unreasonable or exaggerated but feeling powerless to control them

Physical as well as psychological reactions, including sweating, rapid heartbeat, difficulty breathing, a feeling of panic and intense anxiety

In some cases, anxiety just thinking about what you fear

Causes

Much is still unknown about the actual cause of phobias. Studies seem to show a strong correlation between your own phobias and the phobias of your parents, however. Children may learn phobias by observing a family member's phobic reaction to an object or a situation — for example, a fear of snakes or spiders.

Brain chemicals, genetics and traumatic experiences also appear to influence the development of phobias.

Risk factors

Phobias are the most common mental disorder in the United States. Although some phobias seem to have a genetic component, it's often impossible to know who will develop them. These factors, however, may increase your risk:

Your age. Social phobia usually develops early in life, most often between the ages of 11 and 15, and almost never after age 25. Specific phobias having to do with the environment or personal injury also first appear in childhood — as early as age 5. Fear of tunnels, elevators, bridges, flying, driving and other situational phobias usually develop by the mid-20s.

Your sex. Phobias affect both sexes, but women and girls are twice as likely to have social phobia as are men and boys. Women are also more likely to be diagnosed with agoraphobia, but this may be because men tend to hide anxiety or mask it with alcohol. Men are also less likely to seek help for emotional problems than women are.

Your family. If someone in your immediate family has a specific phobia, such as a fear of spiders or snakes, you're more likely to develop it, too.

Complications

Having a phobia may cause other problems, including:

Social isolation. If you have a phobia, you may find that you avoid social situations and public places. Financial, professional and interpersonal problems often result from social phobia and agoraphobia.

Depression. The avoidance of many activities that other people find enjoyable in their personal and professional lives may lead you to become depressed.

Substance abuse. Some people with phobias turn to alcohol or other drugs to deal with stress. This unwise and unhealthy choice can lead to abuse of alcohol or other drugs.

Diagnosis

There are no laboratory tests for phobias. Instead, the diagnosis is based on a thorough clinical interview and rigorous diagnostic guidelines. Your doctor will ask questions about your symptoms and take a medical, psychiatric and social history.

To be diagnosed with a phobia, you must meet certain criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.

Specific phobias

The diagnostic criteria for specific phobias include:

A persistent and intense fear triggered by an object or situation, such as snakes, spiders or storms.

An immediate anxiety response when you confront the source of your fear.

Knowing that your fear is irrational or exaggerated but feeling powerless to control it. This doesn't apply to children, who often don't have the maturity to recognize that their fear is unreasonable.

Avoiding what you fear at all costs, or enduring it with extreme distress.

No other explainable reason for your symptoms, including medical conditions and other anxiety disorders.

In children and teens, symptoms lasting at least six months.

Social phobia

The diagnostic criteria for social phobia include:

A persistent and intense fear of humiliating or embarrassing yourself in one or more social situations — usually with unfamiliar people or when you're under close scrutiny.

Exposure to the situations you fear creates intense anxiety, which may take the form of a panic attack.

Knowing that your fear is unreasonable or exaggerated but feeling powerless to control it.

Avoiding the social or performance situations that you fear or enduring them with extreme distress.

The phobia and its complications severely affect your life, including your job, social activities and relationships.

No other explainable reason for your symptoms, including health problems, medication or other psychological disorder.

In children, additional diagnostic criteria for social phobia include:

Fear and social anxiety with other children, not just with adults.

Anxiety expressed by crying, tantrums, freezing or shrinking from social situations with unfamiliar people.

Often, an inability to realise that their fears are unreasonable.

Phobia lasting at least six months.

Agoraphobia

The criteria for a diagnosis of agoraphobia include:

An irrational fear of being alone in a place or situation where you would be unable to find help or to escape easily if you were to have a panic attack. People with agoraphobia might fear being in a large crowd, standing in line, or traveling on a bus, train or automobile. In the most severe cases, they may never leave the house.

The avoidance of anxiety-provoking situations whenever possible. Having to face these situations causes extreme distress.

No other explainable reason for your symptoms, such as a medical condition, medication or other psychological disorder.